括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的临床观察

摘要

目的 比较括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的疗效.方法 选取2012年11月至2015年11月本院收治的88例复杂性肛瘘患者为研究对象,随机分为A组与B组,每组各44例,A组行括约肌间瘘管结扎术,B组采取切开挂线术.比较两组治疗总有效率、手术时间、术中出血量、创口面积、创口愈合时间、住院时间、并发症总发生率及肛门功能.结果 A组治疗总有效率为93.18％,显著高于B组的77.27％(P＜ 0.05).A组手术时间长于B组,A组术中出血量、创口面积、创口愈合时间、住院时间均优于B组(均P＜ 0.05).A组术后并发症总发生率为18.18％,显著低于B组的38.64％(P＜ 0.05).两组术前的Wexner评分差异无统计学意义(P＞0.05).A组术后1周、1个月、3个月、6个月、12个月的Wexner评分均显著低于B组(均P＜0.05).结论 与切开挂线术相比,括约肌间瘘管结扎术治疗复杂性肛瘘的总体疗效更优,利于患者术后康复.%Objective To compare the risk of leakage and constipation of anal fistula treated by intersphincteric fistula ligation and dissected and seton therapy.Methods Eighty-eight cases with complex anal fistula were randomly divided into group A and group B,with 44 cases in each group.Group A was treated by intersphincteric fistula ligation andgroup B by dissected and seton therapy.The total effective rate,operation time,intraoperative bleeding volume,wound area,wound healing time,length of hospital stay,total incidence rate of complications and postoperative anal function were compared between the two groups.Results The total effective rate in group A (93.18％)was higher than that in group B (77.27％)(P ＜ 0.05).The operation time of group A was longer than that of group B,and the intraoperative bleeding volume,wound area,wound healing time,and length of hospital stay were less,smaller and shorter than those of group B (P ＜ 0.05).The incidence of postoperative complications in group A (18.18％)was lower than that in group B (38.64％) (P ＜ 0.05).There was no significance in Wexner score preoperative between the two groups (P ＞ 0.05).One week,1 month,3 months,6 months and 12 months after operation,the Wexner scores in group A were all lower than those in group B (P ＜ 0.05).Conclusion Intersphincteric fistula ligation in the treatment of complex anal fistula is more in line with the concept of minimally invasive operation,and patients can recover more quickly.It can help preserve the whole sphincter,and the risk of leakage and constipation is smaller than dissected and seton therapy.The anal function is better preserved.It has the potential of wideclinical application.